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Hu B, Jin H, Li X, Wu X, Xu J, Gao Y. The predictive value of total-body PET/CT in non-small cell lung cancer for the PD-L1 high expression. Front Oncol 2022; 12:943933. [PMID: 36212409 PMCID: PMC9538674 DOI: 10.3389/fonc.2022.943933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Total-body positron emission tomography/computed tomography (PET/CT) provides faster scanning speed, higher image quality, and lower injected dose. To compensate for the shortcomings of the maximum standard uptake value (SUVmax), we aimed to normalize the values of PET parameters using liver and blood pool SUV (SUR-L and SUR-BP) to predict programmed cell death-ligand 1 (PD-L1) expression in non-small cell lung cancer (NSCLC) patients. Materials and methods A total of 138 (104 adenocarcinoma and 34 squamous cell carcinoma) primary diagnosed NSCLC patients who underwent 18F-FDG-PET/CT imaging were analyzed retrospectively. Immunohistochemistry (IHC) analysis was performed for PD-L1 expression on tumor cells and tumor-infiltrating immune cells with 22C3 antibody. Positive PD-L1 expression was defined as tumor cells no less than 50% or tumor-infiltrating immune cells no less than 10%. The relationships between PD-L1 expression and PET parameters (SUVmax, SUR-L, and SUR-BP) and clinical variables were analyzed. Statistical analysis included χ2 test, receiver operating characteristic (ROC), and binary logistic regression. Results There were 36 patients (26%) expressing PD-L1 positively. Gender, smoking history, Ki-67, and histologic subtype were related factors. SUVmax, SUR-L, and SUR-BP were significantly higher in the positive subset than those in the negative subset. Among them, the area under the curve (AUC) of SUR-L on the ROC curve was the biggest one. In NSCLC patients, the best cutoff value of SUR-L for PD-L1-positive expression was 4.84 (AUC = 0.702, P = 0.000, sensitivity = 83.3%, specificity = 54.9%). Multivariate analysis confirmed that age and SUR-L were correlated factors in adenocarcinoma (ADC) patients. Conclusion SUVmax, SUR-L, and SUR-BP had utility in predicting PD-L1 high expression, and SUR-L was the most reliable parameter. PET/CT can offer reference to screen patients for first-line atezolizumab therapy.
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Affiliation(s)
| | | | | | | | - Junling Xu
- *Correspondence: Junling Xu, ; Yongju Gao,
| | - Yongju Gao
- *Correspondence: Junling Xu, ; Yongju Gao,
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Divisi D, Rinaldi M, Necozione S, Curcio C, Rea F, Zaraca F, De Vico A, Zaccagna G, Di Leonardo G, Crisci R. Is It Possible to Establish a Reliable Correlation between Maximum Standardized Uptake Value of 18-Fluorine Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Histological Types of Non-Small Cell Lung Cancer? Analysis of the Italian VATS Group Database. Diagnostics (Basel) 2021; 11:diagnostics11101901. [PMID: 34679600 PMCID: PMC8534503 DOI: 10.3390/diagnostics11101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although positron emission tomography/computed tomography, often integrated with 2-deoxy-2-[fluorine-18] fluorine-D-glucose (18F-FDG-PET/CT), is fundamental in the assessment of lung cancer, the relationship between metabolic avidity of different histotypes and maximum standardized uptake value (SUVmax) has not yet been thoroughly investigated. The aim of the study is to establish a reliable correlation between Suvmax and histology in non-small cell lung cancer (NSCLC), in order to facilitate patient management. METHODS We retrospectively assessed the data about lung cancer patients entered in the Italian Registry of VATS Group from January 2014 to October 2019, after establishing the eligibility criteria of the study. In total, 8139 patients undergoing VATS lobectomy were enrolled: 3260 females and 4879 males. The relationship between SUVmax and tumor size was also analyzed. RESULTS The mean values of SUVmax in the most frequent types of lung cancer were as follows: (a) 4.88 ± 3.82 for preinvasive adenocarcinoma; (b) 5.49 ± 4.10 for minimally invasive adenocarcinoma; (c) 5.87 ± 4.18 for invasive adenocarcinoma; and (d) 8.85 ± 6.70 for squamous cell carcinoma. Processing these data, we displayed a statistically difference (p < 0.000001) of FDG avidity between adenocarcinoma and squamous cell carcinoma. Moreover, by classifying patients into five groups based on tumor diameter and after evaluating the SUVmax value for each group, we noted a statistical correlation (p < 0.000001) between size and FDG uptake, also confirmed by the post hoc analysis. CONCLUSIONS There is a correlation between SUVmax, histopathology outcomes and tumor size in NSCLC. Further clinical trials should be performed in order to confirm our data.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
- Correspondence: or ; Tel.: +39-0861-42-94-82; Fax: +39-0861-42-94-78
| | - Marta Rinaldi
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Stefano Necozione
- Department of Internal Medicine and Public Health, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Carlo Curcio
- Division of Thoracic Surgery, Monaldi Hospital, 80131 Naples, Italy;
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova City Hospital, 35100 Padova, Italy;
| | - Francesco Zaraca
- Department of Vascular and Thoracic Surgery, Central Hospital, 39100 Bolzano, Italy;
| | - Andrea De Vico
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Gino Zaccagna
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Gabriella Di Leonardo
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
| | - Roberto Crisci
- Thoracic Surgery Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, “Giuseppe Mazzini” Hospital, Piazza Italia 1, 64100 Teramo, Italy; (M.R.); (A.D.V.); (G.Z.); (G.D.L.); (R.C.)
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Seol HY, Kim YS, Kim SJ. Diagnostic test accuracy of 18F-FDG PET/CT for prediction of programmed death ligand 1 (PD-L1) expression in solid tumours: a meta-analysis. Clin Radiol 2021; 76:863.e19-863.e25. [PMID: 34261597 DOI: 10.1016/j.crad.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
AIM To investigate the predictive value of integrated 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT) for the prediction of programmed death ligand 1 (PD-L1) expression in solid tumours via a systematic review and meta-analysis. MATERIALS AND METHODS The PubMed, Cochrane, and EMBASE databases, from the earliest available date of indexing through 31 October 2020, were searched for studies evaluating the diagnostic performance of 18F-FDG PET/CT for prediction of PD-L1 expression in solid tumours other than lung cancer. RESULTS Across seven studies (473 patients), the pooled sensitivity for 18F-FDG PET/CT was 0.75 (95% confidence interval [CI]: 0.65-0.82) without heterogeneity (I2 = 47.2, p=0.08) and a pooled specificity of 0.73 (95% CI: 0.64-0.81) with heterogeneity (I2 = 53.8, p=0.04). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 2.8 (95% CI: 2.1-3.7) and negative likelihood ratio (LR-) of 0.35 (95% CI: 0.26-0.47). The pooled diagnostic odds ratio (DOR) was 8 (95% CI: 5-13). Hierarchical summary receiver operating characteristic (ROC) curve and indicates that the area under the curve was 0.80 (95% CI: 0.77-0.84). CONCLUSION The current meta-analysis showed a moderate sensitivity and specificity of 18F-FDG PET/CT for the prediction of PD-L1 expression in solid tumours. At present, the literature regarding the use of 18F-FDG PET/CT for the prediction of PD-L1 expression in solid tumours still limited; thus, further large multicentre studies would be necessary to substantiate the diagnostic accuracy of 18F-FDG PET/CT for prediction of PD-L1 expression in solid tumours.
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Affiliation(s)
- H Y Seol
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea
| | - Y S Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea
| | - S-J Kim
- Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea; Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea; BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, 50612, Republic of Korea.
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Zhao L, Liu J, Wang H, Shi J. Association between 18F-FDG metabolic activity and programmed death ligand-1 (PD-L1) expression using 22C3 immunohistochemistry assays in non-small cell lung cancer (NSCLC) resection specimens. Br J Radiol 2021; 94:20200397. [PMID: 33492995 DOI: 10.1259/bjr.20200397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study sought to investigate the association between 18F-fludeoxyglucose (18F-FDG) uptake in positron emission tomography/CT (PET/CT) scans and different programmed death ligand-1 (PD-L1) expression conditions in non-small cell lung cancer (NSCLC). METHODS From October 2017 to December 2019, NSCLC was retrospectively identified in 419 consecutive patients who underwent 18F-FDG PET/CT scans and PD-L1 expression tests using the PD-L1 22C3 assay. The association between clinicopathological characteristics and PD-L1 expression was assessed. RESULTS The frequency of PD-L1-positive tumours was 38.2% (160/419) in NSCLC. In NSCLC, the multivariate analysis showed a high maximum standardised uptake value (SUVmax) (p < 0.0001) and an EGFR wild type genotype (p = 0.027) was significantly associated with PD-L1-positivity. In adenocarcinoma (ADC), the multivariate analysis showed that a high SUVmax (p < 0.0001) was significantly associated with PD-L1-positivity. In NSCLC and ADC, a Mann-Whitney U test showed significant differences between groups with PD-L1 high expression and PD-L1 low expression levels in terms of SUVmax (p = 0.011 and p = 0.013, respectively). The results of the receiver operating characteristic curve analysis showed that the area under the curve of the SUVmax was 0.767 (95% CI, 0.720-0.814; p < 0.0001) and 0.712 (95% CI, 0.651-0.774; p < 0.0001) in NSCLC and ADC, respectively. CONCLUSION The study demonstrates that the SUVmax was significantly associated with PD-L1 expression in NSCLC and ADC. The SUVmax was significantly different between the PD-L1 high and low expression conditions, as quantified using a PD-L1 22C3 assay. ADVANCES IN KNOWLEDGE This study provides direct evidence that SUVmax as a metabolic biomarker may help select patients with NSCLC likely to benefit from pembrolizumab.
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Affiliation(s)
- Long Zhao
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai 200433, China
| | - Jinjun Liu
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai 200433, China
| | - Huoqiang Wang
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai 200433, China
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Shanghai 200433, China
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Seol HY, Kim YS, Kim SJ. Predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography for PD-L1 expression in non-small cell lung cancer: A systematic review and meta-analysis. Thorac Cancer 2020; 11:3260-3268. [PMID: 32951338 PMCID: PMC7605997 DOI: 10.1111/1759-7714.13664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
Background The purpose of the current study was to investigate the predictive value of 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) for programmed death ligand 1 (PD‐L1) in non‐small cell lung cancer (NSCLC) patients through a systematic review and meta‐analysis. Methods The PubMed, Cochrane, and EMBASE database, from the earliest available date of indexing through 30 April 2020, were searched for studies evaluating the diagnostic performance of 18F‐FDG PET/CT for prediction of PD‐L1 expression in NSCLC patients. Results Across six studies (1739 patients), the pooled sensitivity for 18F‐FDG PET/CT was 0.72 (95% CI: 0.58–0.82) with heterogeneity (I2 = 90.9, P < 0.001) and a pooled specificity of 0.69 (95% CI: 0.64–0.74) with heterogeneity (I2 = 77.9, P < 0.001). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR +) of 2.3 (95% CI: 1.8–2.9) and negative likelihood ratio (LR‐) of 0.41 (95% CI: 0.26–0.63). The pooled diagnostic odds ratio (DOR) was six (95% CI: 3–11). Hierarchical summary receiver operating characteristic (ROC) curve indicated that the area under the curve was 0.74 (95% CI: 0.70–0.78). Conclusions The current meta‐analysis showed a moderate sensitivity and specificity of 18F‐FDG PET/CT for the prediction of PD‐L1 expression in NSCLC patients. The DOR was low and the likelihood ratio scatter‐gram indicated that 18F‐FDG PET/CT might not be useful for the prediction of PD‐L1 expression in NSCLC patients and not for its exclusion. Key points Significant findings of the study The current meta‐analysis showed a moderate sensitivity and specificity of 18F‐FDG PET/CT for the prediction of PD‐L1 expression in NSCLC patients. The DOR was low and the likelihood ratio scattergram indicated that 18F‐FDG PET/CT might not be useful for the prediction of PD‐L1 expression in NSCLC patients and not for its exclusion. What this study adds This study concluded that the role of 18F‐FDG PET/CT in predicting tumor expression of PD‐L1 should be further elucidated.
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Affiliation(s)
- Hee Yun Seol
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yun Seong Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, South Korea.,Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea.,BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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